EHR redesign to support cognitive work

Current electronic health records (EHRs) are not optimized to help clinicians think about, diagnose or treat patient problems, and do not optimally support teamwork in primary care. This project develops new EHR interfaces (data displays and inputs) to support primary care providers and their teams. Funded by a R01 grant, we have analyzed the cognitive needs of primary care users and created interfaces in which information is easily accessible for decision-making, while addressing the deficiencies of existing EHR designs.

The healthcare industry is increasingly aware of issues of sub-optimal care quality, waste and burnout, many of which are related to EHR usability (or lack thereof) and unrealized gains from EHR use. While EHR vendors are making changes to their products, many of these “improvements” are not based on an understanding of the cognitive needs of PCPs and their teams.

It is now well accepted in the healthcare informatics and research communities that current EHRs were not designed to support cognitive work and that this is the root of the problem with EHRs. In fact, the Request for Funding Announcement from AHRQ that led to funding the Tandem EHR project was a call to study cognitive work in healthcare and create a technology prototype, defining this as an area of great need. AHRQ agreed with us that PCPs and their teams in primary care were particularly in need of help.

Keeping teams at the center

In settings like primary care, where team members are working together under time pressure in a complex environment full of information, they must share an understanding of the status of the patient and the ongoing care activities. Our goal is to maximize the efficiency and quality of care. Our interfaces are designed to effectively support teamwork and the shared situation awareness of primary care teams.

Research Behind Our Design

This project is funded by an R01 grant from the Agency for Healthcare Research and Quality (#1R01HS022505-01A1).

Our multidisciplinary team includes research staff, primary care physicians, and industrial engineers with expertise in human factors and analysis of cognitive work.

“There often is some difficulty in finding information about a patient during a visit, and being able to see everything in one location improves the efficiency and effectivity of the visit.”

– Physician, MD

We used a Human Factors Engineering design methodology focused on situation awareness to inform the design of our user interface. To do this we:

  • Conducted observations and cognitive interviews to collect detailed information about the goals, decisions and information needs of users (220 hours of observation, 195 interviews)
  • Created goal-directed task analysis maps of information gathered
  • Designed a complete set of EHR interfaces, fully developing 16 sections with examples and a task management module
  • Performed usability testing with end users 

Value of the Tandem EHR

The value that the Tandem EHR brings to healthcare in general and primary care specifically is enormous. When fully implemented, our EHR will:

  • improve productivity
  • increase access to needed information and decision-making
  • improve practice satisfaction and decrease burnout levels
  • improve the quality and safety of the care delivered to primary care patients
  • ultimately decrease costs for organizations through less waste and staff turnover

We have valuable products to disseminate and implement from this work including the cognitive requirements of PCPs and their teams and the EHR interfaces themselves. We are strongly motivated to disseminate our products and see them used in practice.